Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What clinical factors influence your first line treatment selection in advanced HCC?
With now many options of therapy for the treatment of advanced HCC, this is good news. It is also a challenge of how to pick and choose, and what factors may influence the choice of first line treatment.The possible choices would be either the combination of checkpoint inhibitor plus an add-on thera...
Do you approach the treatment of post-lumpectomy DCIS which is only present within an intraductal papilloma differently, if it does not involve adjacent breast tissue?
From the medical oncology perspective, I would consider chemoprevention with endocrine therapy for this patient. Prior series have shown elevated relative risk in patients with papillomas with atypical cells (although not as high as DCIS itself). I am not sure about the size of the DCIS within the p...
For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?
I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local control ...
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
Does a very high Oncotype score influence your approach to adjuvant treatment in a patient with ER positive breast cancer?
This is a very intriguing question that has a simple answer. There is no data on choice or aggressiveness of chemotherapy and resulting benefit in patients with higher oncotype recurrence score. What regimen to use remains a judgement call, but for most patients with ER+/node negative tumors with a ...
Would you use bone marrow MRD status to guide stopping daratumumab early at 1 year instead of the recommended 3 years of therapy per the AQUILA trial for high-risk smoldering myeloma?
I would venture to say that there is probably a 0% chance that MRD negativity would be achieved with daratumumab alone. The CR rate was 8.8%, but MRD was not assessed, and I would doubt that MRD negativity was achieved in any patient. That said, we can't really extrapolate whether 1 year and stoppin...
Would you use bone marrow MRD status to guide stopping daratumumab early at 1 year instead of the recommended 3 years of therapy per the AQUILA trial for high-risk smoldering myeloma?
I would venture to say that there is probably a 0% chance that MRD negativity would be achieved with daratumumab alone. The CR rate was 8.8%, but MRD was not assessed, and I would doubt that MRD negativity was achieved in any patient. That said, we can't really extrapolate whether 1 year and stoppin...
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
When would you recommend abiraterone concurrently with RT for high-risk prostate cancer?
The trial got published in NEJM. It confirms survival advantage and skeletal mets advantage with abiraterone for metastatic disease similar to the Latitude study. This will certainly be an option for metastatic disease at presentation (along with docetaxel until comparative studies comparing docetax...
When do you choose a non-anthracycline containing regimen, such as docetaxel/cyclophosphamide, for patients with hormone receptor positive, HER2 negative breast cancer who warrant adjuvant chemotherapy?
As in many of the decisions we face, we need to balance benefit and risk. Based on the ABC suite of trials, anthracycline regimens are slightly more effective than non-anthracycline (taxane only) regimens. To be clear, the ABC data is far from perfect - the trial design changed at least 3 times duri...